Project Summary: Our proposal provides a plan to guide the next generation of enhancements and updates to the vison and eye health surveillance system (VEHSS) through the three aims of maintaining and updating VEHSS, expanding the estimates contained in VEHSS, and studying the validity of VEHSS indicators. Under our prior direction, VEHSS tracks over 100 visual health indicators by U.S. State as measured in 12 unique datasets including national surveys, administrative claims databases, electronic health record registries and published eye examination studies and estimated using over 250 million patient-level records per year. Each included dataset is analyzed using consistent definitions of age categories, sex, race/ethnicity and risk factors, allowing direct comparisons between different data for the first time. Prevalence and other indicators from VEHSS are freely available to the public via online visualization, system generated PDF reports, and customizable and privacy-secured public use files. The VEHSS website launched in summer 2018 with initial datasets and system documentation. By the summer of 2019, VEHSS will contain all 12 datasets, detailed indicator definitions, and state-level dashboards summarizing indicator information for use by state and local health departments, researchers and others interested in state information. Also by September 2019 the VEHSS will create and host multi-source, meta-analytic estimates of visual impairment, blindness, age-related macular degeneration, cataracts, diabetic retinopathy and glaucoma, the first such updates since 2004. In this proposal, we present a plan to guide VEHSS development over the next three years through a series of seven concurrent tasks; 1. Engage committed experts; 2. : Maintaining the VEHSS data system and identifying and selecting new valid data sources; 3. Analysis of data and estimation; 4. Maintenance and development of the VEHSS Website; 5. Review and validate vision and eye health indicators; 6. Engagement and Dissemination; and 7. Project Management. Our proposal provides concrete work steps to assure the continued and expanded functionality of VEHSS's single data-source estimates and to expand these estimate to contain vital county level information for the sources that support them. We describe how we will use of the project's innovative multi-source meta-regression model to create estimates of vision loss and blindness at the state and county level, and to create new state-level prevalence estimates for two new conditions. Finally, we propose a qualitative and empirical study of the VEHSS indicators using a unique dataset and following established validation theory. If successful, the work of this project will directly support government, the research community, and the general public in efforts to reduce the burden of and disparities in visual health disorders, including state and local tracking of Healthy People 2020 objectives at the national, state and local level.